Recurrence of kernicterus in term and near‐term infants in Denmark

Classical acute bilirubin encephalopathy (kernicterus) in term and near‐term infants had not been seen in Denmark for at least 20 y until 1994. From 1994 to 1998, however, six cases were diagnosed. Aetiology of the hyperbilirubinaemia was known in two infants; spherocytosis and galactosaemia, most likely known in two infants; possible A‐O blood type immunization, and unknown in two infants. However, one of these last‐mentioned infants had a gestational age of only 36 wk. The maximum plasma total bilirubin concentrations were 531–745 μmol/L. The increase in the number of cases of kernicterus was considered to have been caused by: (i) a decreased awareness of the pathological signs, (ii) a change in the assessment of the risk of bilirubin encephalopathy, (iii) early discharge of the infants from the maternity ward, (iv) so‐called breastfeeding‐associated jaundice, (v) demonstration of bilirubin being an antioxidant, and (vi) difficulty in estimating the degree of jaundice in certain groups of immigrants. Accordingly, for prevention: (a) Attempt to change the healthcare workers' understanding of the risk of bilirubin encephalopathy, (b) give further instructions, both orally and in writing, to mothers before discharge from the maternity ward, (c) be more liberal in giving infant formula supplements, (d) conduct home visits by the community nurse at an earlier stage, (e) follow authorized guidelines for phototherapy and exchange transfusion, (f) lower plasma bilirubin concentration limits as an indication for phototherapy and exchange transfusion, (g) screen all term and near‐term infants, and (h) measure the skin's yellow colour with a device that corrects for the skin's melanin content.

[1]  D. Stevenson,et al.  Prediction of Hyperbilirubinemia in Healthy Term- and Near-Term Chinese Newborns , 1999 .

[2]  V. Bhutani,et al.  Transcutaneous Measurement (TcB) of Total Serum Bilirubin (TSB) by Multi-Wavelength Spectral Reflectance (BiliCheck™): Accuracy and Precision in Newborn Babies , 1999 .

[3]  M. J. Maisels,et al.  Noninvasive Measurement of Serum Bilirubin , 1999 .

[4]  V. Bhutani,et al.  Predictive Ability of a Predischarge Hour-specific Serum Bilirubin for Subsequent Significant Hyperbilirubinemia in Healthy Term and Near-term Newborns , 1999, Pediatrics.

[5]  A. Meberg,et al.  Screening for neonatal hyperbilirubinaemia and ABO alloimmunization at the time of testing for phenylketonuria and congenital hypothyreosis , 1998, Acta paediatrica.

[6]  Christensen Ae.  Kernicterus in a full term infant , 1996 .

[7]  M. J. Maisels,et al.  Kernicterus in otherwise healthy, breast-fed term newborns. , 1995, Pediatrics.

[8]  M. G. Macdonald,et al.  Hidden risks: early discharge and bilirubin toxicity due to glucose 6-phosphate dehydrogenase deficiency. , 1995, Pediatrics.

[9]  W. Moneit.  Kernicterus in a full-term infant: the need for increased vigilance. , 1995, Pediatrics.

[10]  D. Hall,et al.  Screening in infancy. , 1995, Archives of disease in childhood.

[11]  L. Gartner.  On the question of the relationship between breastfeeding and jaundice in the first 5 days of life. , 1994, Seminars in perinatology.

[12]  Sheldon,et al.  Bilirubin production in healthy term infants as measured by carbon monoxide in breath. , 1994, Clinical chemistry.

[13]  M. Hiatt,et al.  The protective role of bilirubin in oxygen-radical diseases of the preterm infant. , 1994, Journal of perinatology : official journal of the California Perinatal Association.

[14]  P. Rosenthal.  DIRECT BILIRUBIN MEASUREMENTS IN TERM NEWBORNS—A WASTE OF TIME AND MONEY? , 1992, Journal of Pediatric Gastroenterology and Nutrition.

[15]  T B Newman,et al.  Evaluation and treatment of jaundice in the term newborn: a kinder, gentler approach. , 1992, Pediatrics.

[16]  A. Knudsen.  Prediction of later hyperbilirubinaemia by measurement of skin colour on the first postnatal day and from cord blood bilirubin. , 1992, Danish medical bulletin.

[17]  L. Johnson.  Hyperbilirubinemia in the term infant: when to worry, when to treat. , 1991, New York state journal of medicine.

[18]  Y. Yamauchi,et al.  Breast-feeding frequency during the first 24 hours after birth in full-term neonates. , 1990, Pediatrics.

[19]  J. Volpe,et al.  Clinical features of bilirubin encephalopathy. , 1990, Clinics in perinatology.

[20]  A. Mcdonagh,et al.  Is bilirubin good for you? , 1990, Clinics in perinatology.

[21]  M. J. Maisels,et al.  Does hyperbilirubinemia damage the brain of healthy full-term infants? , 1990, Clinics in perinatology.

[22]  M. J. Maisels,et al.  CLINICAL ISSUES: INFANCY AND CHILDHOOD Less Aggressive Treatment of Neonatal Jaundice and Reports of Kernicterus: Lessons About Practice Guidelines , 2000 .

[23]  T. Hansen.  Kernicterus in a full-term infant: the need for increased vigilance. , 1995, Pediatrics.

[24]  T. Hansen,et al.  Effects of sulfisoxazole, hypercarbia, and hyperosmolality on entry of bilirubin and albumin into brain regions in young rats. , 1989, Biology of the neonate.